title: Confocal laser endomicroscopy for prediction of disease relapse in ulcerative colitis: a pilot study.
abstract: OBJECTIVE
  Neoangiogenesis and increased endothelial permeability are observed as results of chronic intestinal inflammation. However, limited data on microvascular and crypt architecture during remission phases is available. The aim of this prospective investigator blinded cohort study was to assess crypt and microvascular architecture and function in ulcerative colitis by probe based confocal laser endomicroscopy; we also evaluated whether these findings may have the potential to predict disease relapse.
  
  
  METHODS
  19 ulcerative colitis patients in clinical and endoscopic remission and 19 controls were studied. A computer based image processing technique was applied to construct 20 mosaicing image sets from each subject. Remitting patients were sub-grouped into either inactive or quiescent disease according to histology.
  
  
  RESULTS
  Pericrypt fluorescence (p<0.01), crypt diameter (p<0.05) but not intercrypt distance (p=0.07) were significantly increased in ulcerative colitis patients compared to controls. Patients with inactive disease showed a significant increase in fluorescence leakage (median fluorescence (IQR), 3888 (3560-4240) vs. 2696 (2502-3390), p<0.01), crypt diameter (median diameter (IQR), 92.5 (85.5-101) vs. 73 (70-77), p<0.05) and intercrypt distance (median distance (IQR), 82.5 (70.5-91.2) vs. 66 (59.5-73.5), p<0.05) compared to those with quiescent disease. A composite outcome score combining fluorescence leakage and crypt diameter was able to predict a disease flare during a 12 month follow-up period (p<0.01).
  
  
  CONCLUSIONS
  In vivo intramucosal changes detected by confocal endomicroscopy in ulcerative colitis remittent patients can predict disease relapse. This observation may have further implications for disease management and medical treatment.
authors.affiliation: Department of Surgical, Gastroenterological and Oncological Sciences, University of Padova, Padova, Italy. Electronic address: andrea.buda@unipd.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Buda
authors.affiliation: Department of Surgical, Gastroenterological and Oncological Sciences, University of Padova, Padova, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Hatem
authors.affiliation: Department of Surgical, Gastroenterological and Oncological Sciences, Division of Gastroenterology, University of Padova, The Netherlands.
authors.forename: Helmut
authors.initials: H
authors.lastname: Neumann
authors.affiliation: Department of Surgical, Gastroenterological and Oncological Sciences, University of Padova, Padova, Italy.
authors.forename: Renata
authors.initials: R
authors.lastname: D'Incà
authors.affiliation: Department of Medicine I Interdisciplinary Endoscopy, University of Erlangen, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Mescoli
authors.affiliation: Department of Pathology, University of Padova, Padova, Italy.
authors.forename: Pierluca
authors.initials: P
authors.lastname: Piselli
authors.affiliation: Department of Epidemiology and Pre-Clinical Sciences, IRCCS "L. Spallanzani", Roma, Italy.
authors.forename: John
authors.initials: J
authors.lastname: Jackson
authors.affiliation: School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Bruno
authors.affiliation: Department of Surgical, Gastroenterological and Oncological Sciences, University of Padova, Padova, Italy.
authors.forename: Giacomo Carlo
authors.initials: GC
authors.lastname: Sturniolo
mesh_terms: D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000473:pathology; D003106:Colon / Q000098:blood supply / Q000473:pathology; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods; D055806:Microvessels / Q000473:pathology; D008875:Middle Aged; D010865:Pilot Projects; D012008:Recurrence
keywords: Confocal laser endomicroscopy;; Microvasculature;; Mucosal healing;; Relapse; Ulcerative colitis;